Provision Of Intensive Care Services Research Articles

Determinants of Mortality of Patients Admitted to the Intensive Care Unit at Debre Berhan Comprehensive Specialized Hospital: A Retrospective Cohort Study.

The provision of intensive care services is advancing globally. However, in resource-limited settings, it is lagging far behind and intensive care unit mortality is still higher due to various reasons. This study aimed to assess determinants of mortality among medical patients admitted to the intensive care unit. A five-year facility-based retrospective Cohort Study was conducted. A total of 546 medical patients admitted to the intensive care unit from March 2017 to February 2022 were included. Document review using a structured questionnaire was implemented to collect data. Data entered into Epi Data were analyzed by STATA and summarized using frequency tables and graphs. Binary and multivariate logistic regression analyses were performed to identify determinants of mortality. The overall mortality was 35.9%. Approximately half of the deaths were attributed to septic shock, congestive heart failure, severe community-acquired pneumonia, and stroke. The most common immediate cause of death was cardio-respiratory arrest. Source of admission, GCS level at admission, duration of ICU stay, treatment with inotropes, septic shock, and retroviral infection status were found to have a statistically significant association with ICU mortality. This study revealed a significantly higher mortality rate among patients admitted to the intensive care unit. Early identification and admission of patients to the intensive care unit are important factors that could decrease mortality. Patient selection is essential since some patients with a high likelihood of mortality might not benefit from intensive care unit admission in an area with high resource limitations.

Speech and language therapy service provision to UK intensive care units: A national survey

BACKGROUND: The role of Speech and Language Therapists (SLTs) in intensive care units (ICUs) has become increasingly recognised. This survey was developed in response to concern amongst UK SLTs that service provision was insufficient. OBJECTIVE: The primary objective was to benchmark and describe UK pre-pandemic SLT ICU service provision. Secondary objectives included: identifying factors which might explain differences in SLT service provision, identifying unmet needs and good practice, and informing recommended SLT staffing levels. METHODS: An online survey was distributed through UK SLT networks and social media. Quantitative data were reported descriptively, and content analysis was conducted with qualitative data. RESULTS: Responses were received from 64 hospitals, representing three paediatric services and 61 adult services. Average staffing ratios of 0.03 and 0.01 whole time equivalent (WTE) were reported for these respectively. Most services (77&) received no funding from their ICU for SLT staffing. Few reported an adequate SLT service for communication (12&), swallowing (16&) and tracheostomy weaning interventions (11&). Compliance with national guidance for SLT-led communication and swallowing input for all tracheostomised patients was achieved by 27& of sites. CONCLUSIONS: Staffing levels at many sites were insufficient to provide a consistent and responsive service. The findings contributed to a recommendation of 0.1 WTE SLT per ICU bed, which was incorporated into Edition 2 of the Guidelines for the Provision of Intensive Care Services. This survey identified barriers and facilitators to providing an adequate SLT service for critically ill patients that may assist service development initiatives and guide further research.

Critical care scientists: Role, training and future directions.

Critical care scientists are a little known but increasingly prominent group of professionals, included in both the government-run Modernising Scientific Careers initiative and 2019 Guidelines for the Provision of Intensive Care Services. This article outlines the role of critical care scientists, their training programme and potential future directions for the role. A wider appreciation and acknowledgement of the critical care scientist's role within the multi-disciplinary team will allow critical care units to fully understand the potential benefits that may be brought to patient care and service delivery.

Cost of intensive care services at a central hospital in South Africa.

Intensive care services are one of the largest cost drivers in a hospital. Increasing life expectancy and comorbidities have resulted in an increased need for intensive care beds. To conduct a cost analysis of intensive care services at a central hospital in the public sector in South Africa (SA). A retrospective cost analysis for the 2015/16 financial year was conducted across two intensive care units (ICUs), a trauma ICU (10 beds) and a combined ICU for neurosurgery, medicine and surgery (18 beds). A mixed-methods costing approach was used based on the availability of data. The bottom-up approach was used to calculate the cost of clinical support, pharmaceuticals, consumables and human resources. The top-down approach was used to allocate the cost of equipment and goods and services. There were 544 admissions resulting in 4 987 inpatient days during the study period. The total estimated inpatient cost across the two ICUs was ZAR114 055 104, with a cost per patient day of ZAR22 870. The combined ICU cost per patient day was 58% higher than the cost per patient day in the trauma ICU (ZAR26 954 v. ZAR17 021). The mean cost per admission was ZAR157 883 in the trauma ICU and ZAR245 087 in the combined ICU. Human resources costs were the highest ICU cost driver (55%), followed by direct patient activity costs (medical consumables, pharmaceuticals, laboratory tests, radiology and blood products), which contributed 24%. This is the first reported cost analysis of intensive care services in SA. Our cost per patient day was higher than that reported in other lower-income countries, but lower than that in high-income countries. These costs vary owing to the different types of ICUs, wide spectrum of disease presentation and availability of diagnostic and treatment options. This study provides useful data that could assist in the planning and provision of intensive care services.

National early warning scores on critical care unit discharge do not predict readmission: A retrospective case–control study

Unplanned readmission to an intensive care unit (ICU) is associated with increased duration of hospital stay, increased resource use and fourfold increase in mortality [ [1] Metnitz P.G.H. Fieux F. Jordan B. Lang T. Moreno R. Le Gall J.R. Critically ill patients readmitted to intensive care units—lessons to learn?. Intensive Care Med. 2003; 29: 241 Crossref PubMed Scopus (109) Google Scholar ]. National guidance for the provision of intensive care services recommends that the rate of early [within 48-h] unplanned readmission should be ≤1.8% of all discharges [ 2 Faculty of Intensive Care Medicine & the Intensive Care Society Guidelines for the Provision of Intensive Care Services. 2016 Google Scholar ]. Potential predictors to avoid this adverse event would improve patient care; these may include the Acute Physiology and Chronic Health Evaluation (APACHE II) score and Simplified Acute Physiology score (SAPS II) [ 3 Frost S.A. Alexandrou E. Bogdanovski T. Salamonson Y. Davidson P.M. Parr M.J. et al. Severity of illness and risk of readmission to intensive care: a meta-analysis. Resuscitation. 2009; 80: 505-510 Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar ]. The National Early Warning Score (NEWS) may be a simple tool for this purpose.

The Impact of Neonatologists' Religiosity and Spirituality on Health Care Delivery for High-Risk Neonates

Ethical decision-making regarding life-sustaining therapies (LST) for high-risk neonates can be challenging for both neonatologists and parents. Parents depend on neonatologists to interpret complex information, identify critical opportunities for decision-making, and present options for care. How neonatologists' belief systems affect care delivery for critically ill newborns is unexplored. To characterize the relationship between neonatologists' religiosity or spirituality and the provision of intensive care services for high-risk newborns. Neonatologists practicing at an American Academy of Pediatrics Neonatal-Perinatal Training Program were surveyed about their religious/spiritual beliefs, provision of LST for critically ill neonates, and communication with families. Two hundred ninety-eight neonatologists responded to the survey; 66.4% consider themselves very or moderately spiritual, 40.8% very or moderately religious. In response to a hypothetical prenatal consultation for a fetus at 23 1/7 weeks gestation, 96.3% agreed that the physician has a moral obligation to present all options to parents, including the provision of comfort care. More than 95% had no objection to withholding or withdrawing LST, with religion playing almost no part in these decisions. 38% of participants reported no objection to resuscitating an infant with trisomy 13 or 18; 40% of these neonatologists considered themselves very/moderately religious, 60% slightly/not at all religious. Eighty-nine neonatologists reported that their religious beliefs influence their medical practice. These physicians had similar responses as those not influenced by religion. For the majority of neonatologists participating in this study, differences in critical care practice cannot be attributed to personal religious or spiritual views.

The ongoing H1N1 flu pandemic and the intensive care community: challenges, opportunities, and the duties of scientific societies and intensivists

This year has brought a new challenge to Intensive Care Medicine. The current influenza A (H1N1) pandemic may have a disproportionate effect on the provision of Intensive Care services in Europe. These challenges cause many anxieties for practicing clinicians, both as to what to expect, how to practice and what support or help they will be given. In this statement from the European Society of Intensive Care Medicine (ESICM), we aim to describe some of the facts, the fears and the areas where scientific societies can help to improve our understanding of these problems and at the same time reduce the impact of these issues for our members and their patients.

Authors misinterpreted results of study that they cited

EDITOR,—D F Bowden and D P Burke's suggestion that the major injuries unit in Birmingham contributes to the current lack of provision of intensive care services in the city is based on incorrect facts and lack of understanding of the situation.1 This is partly due to a misreading or a misinterpretation of a thesis that does not support their assertions.2 The number of patients admitted to the five …

Crisis in the provision of intensive care services: the case for high-dependency care.

Several reports have recently highlighted the problem of providing sufficient intensive care beds to meet the needs of critically ill patients (Bennett, 1995; Department of Health (DoH), 1995a). In response to these reports, the British Association of Critical Care Nurses (BACCN) issued a position statement which expressed the belief that: